Accuracy of point of care ultrasound in the diagnosis of long bone fractures in the emergency department.

Introduction: Long bone fractures account for a significant portion of injuries in the emergency department (ED). This study aimed to determine the accuracy of point of care ultrasound (POCUS) compared to x-ray in the diagnosis of long bone fractures in the ED. Method: This cross-sectional study assessed 147 patients presenting to the ED of Patan Academy of Health Sciences (PAHS), with suspected long bone fractures, from Oct 2021   through Jun 2022. In all patients, POCUS examination was done by emergency fellows and then standard plain x-ray was performed. Data were analyzed by SPSS 28.0 to determine sensitivity and specificity. Result: A total of 147 patients were included in the study. Compared with x-ray, sensitivity, specificity, PPV and NPV of POCUS in determining fractures was found to be 86%, 98.96%, 97.72% and 93.2%, respectively. Based on bone injured, the highest sensitivity and specificity were obtained with forearm fractures, which was equal to 97.22% and 100%, respectively. Based on age categorization, the highest sensitivity (100%) and specificity (100%) were obtained in pediatric age group i.e. up to 16 years. Conclusion: This study demonstrated that POCUS has high sensitivity and specificity in the diagnosis of long bone fractures, compared to x-ray

Large Emphysematous bulla after COVID 19 Pneumonia

A 38 year old man, with history of COVID 19 pneumonia 23 days back, non smoker and known case of hypertension presented to the emergency department with complain of sudden onset multiple episodes of blood mixed sputum associated with shortness of breath and sharp type of left sided chest pain for last five hours. The patient was dyspneic, tachypneic and hypoxemic at the time of examination with SPO2 of 84 to 86% without oxygen which improved to 95-96% after 15 liter/min of oxygen via high flow nasal cannula. There were no breath sounds in left hemithorax and decreased breath sound on right side with basal crepitations. Chest radiograph revealed left sided pneumothorax, needle decompression done immediately followed by chest tube insertion and maintaining 95-96%oxygen at 8 liter/min after the procedure. The patient was admitted, and HRCT revealed giant emphysematous bulla in posteromedial aspects of left lobe. This is to highlight the complications that were observed in post covid patien